title: Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study.
abstract: OBJECTIVE
  To develop a score predicting the risk of bacteremia in cancer patients with fever and neutropenia (FN), and to evaluate its performance.
  
  
  METHODS
  Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of bacteremia was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules.
  
  
  RESULTS
  Bacteremia was reported in 67 (16%) of 423 FN episodes. In 34 episodes (8%), bacteremia became known only after reassessment after 8 to 24 hours of inpatient management. Predicting bacteremia at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The reassessment score predicting future bacteremia in 390 episodes without known bacteremia used the following 4 variables: hemoglobin ≥ 90 g/L at presentation (weight 3), platelet count <50 G/L (3), shaking chills (5), and other need for inpatient treatment or observation according to the treating physician (3). Applying a threshold ≥ 3, the score--simplified into a low-risk checklist--predicted bacteremia with 100% sensitivity, with 54 episodes (13%) classified as low-risk, and a specificity of 15%.
  
  
  CONCLUSIONS
  This reassessment score, simplified into a low-risk checklist of 4 routinely accessible characteristics, identifies pediatric patients with FN at risk for bacteremia. It has the potential to contribute to the reduction of use of antimicrobials in, and to shorten the length of hospital stays of pediatric patients with cancer and FN.
authors.affiliation: Department of Pediatrics, University of Bern, Bern, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Agyeman
authors.forename: Christoph
authors.initials: C
authors.lastname: Aebi
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirt
authors.forename: Felix K
authors.initials: FK
authors.lastname: Niggli
authors.forename: David
authors.initials: D
authors.lastname: Nadal
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Hulya
authors.initials: H
authors.lastname: Ozsahin
authors.forename: Udo
authors.initials: U
authors.lastname: Kontny
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühne
authors.forename: Maja
authors.initials: M
authors.lastname: Beck Popovic
authors.forename: Kurt
authors.initials: K
authors.lastname: Leibundgut
authors.forename: Nicole
authors.initials: N
authors.lastname: Bodmer
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016470:Bacteremia / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D000970:Antineoplastic Agents